MEDICARE: KRUTI INTERNAL MEDICINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356485486
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KRUTI INTERNAL MEDICINE

Provider Business Mailing Address
First Line	:	1724 DAFFODIL TRL
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-5210
Country	:	US
Telephone Number	:	330-502-2194
Fax Number	:

Provider Business Practice Location Address
First Line	:	1724 DAFFODIL TRL
Second Line	:
City	:	POLAND
State	:	OH
Zip	:	44514-5210
Country	:	US
Telephone Number	:	330-502-2194
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KRUTI SHAH
Credential	:	MD
Telephone Number	:	330-502-2194

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	08/22/2020

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